Ophthalmic surgical cutting system with varied cross section tube-set

ABSTRACT

An ophthalmic surgical cutting apparatus. In one instance, the apparatus includes a pneumatically-powered surgical cutter driven by a pneumatic pulse generator and a tubing assembly comprising multi-stage tubing connecting the generator to the cutter. The multi-stage tubing has a length of about two feet or more and includes a first-stage tube and a second-stage tube. The first-stage tube has a first end coupled to the output port of the generator, a second end opposite the first end, and a first inner channel having a first diameter for transmitting the pressure pulses to the cutter. The second-stage tube has a first end in pneumatic communication with the second end of the first-stage tube, a second end opposite the first end of the second-stage tube coupled to the cutter, and a second inner channel having a second diameter different than the first diameter for transmitting the pressure pulses to the cutter.

RELATED APPLICATIONS

This application is a divisional application of and claims priority to U.S. application Ser. No. 13/485,324 filed May 31, 2012, the entire content of which is herein incorporated by reference.

FIELD

Embodiments of the invention relate to surgical cutting devices and tubing used to transmit pressure pulses to such devices.

BACKGROUND

Surgical cutting devices are sometimes pneumatically driven. An ophthalmic cutting device is an example of such a surgical instrument and is used in eye surgery. A guillotine-style ophthalmic cutting device may be used to remove portions of the vitreous humor of the eye. A guillotine-style ophthalmic cutting device includes two principal parts: (1) a hollow needle including a cutting port and (2) a slidable (usually reciprocating), cutter positioned inside the needle. The cutter may also be hollow. In use, the ophthalmic cutting device is inserted into an incision in the eye. As vitreous tissue enters the port of the needle, the cutter slides past the port to cut the tissue. A vacuum may be applied to the cutter to remove the cut tissue from the cutting device.

SUMMARY

To move the cutter and perform the cutting, a driver, such as a pneumatic pulse generator, generates pressure pulses (e.g., of air or nitrogen) that are transmitted from the pressure pulse generator to the cutter via tubing connecting the cutting device to the driver. The cutter may be biased into a non-cutting position by a static biasing force (e.g., using a preloaded spring). The pressure pulses travel the length of the tubing and push the cutter against the bias (e.g., through a flexible diaphragm) and into a cutting position where the cutter slides past the cutting port of the needle and cuts the tissue. Between peaks of the pressure pulses, the pressure in the tubing is vented to atmosphere. Therefore, the pressure pulses return through the tubing to the pneumatic pulse generator, which allows the biasing force to return the cutter to the noncutting position. Accordingly, each pressure pulse results in a cutting motion of the cutter.

In another embodiment, the cutter in the cutting device may have little or no biasing force holding the cutter in the non-cutting position. In this embodiment, two pneumatic pulses (for example, generated by two pulse generators) are used. A first pressure pulse generator transmits pressure pulses to the cutting device to force the cutter into the cutting position. A second pressure pulse generator transmits pressure pulses to restore the cutter to the non-cutting position. Therefore, this embodiment uses two parallel lengths of tubing to drive the cutting device. In some embodiments, the two pressure pulse generators are embodied as a single device. The single device can include two pulse generators, each with a separate output. In other embodiments, the device can include a single pulse generator and at least two outputs supplying pulse trains from the single pulse generator at different phases. The pulse trains may have different amplitudes, frequencies, and/or phases. To provide precise cutting movements of the cutter, embodiments of the invention provide an ophthalmic surgical cutting apparatus. The surgical cutting apparatus includes a surgical cutter and a tubing assembly. The tubing assembly includes multi-stage tubing configured to be connected to a pneumatic pulse generator and to the surgical cutter. The multistage tubing transmits pressure pulses to the surgical cutter. The multi-stage tubing has a length of about two feet or more and includes a first-stage and a second-stage. The first-stage has a first end configured to be connected to an output port of the pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the pressure pulses to the surgical cutter. The first inner channel has a first cross-sectional area. The second-stage has a first end configured to be in pneumatic communication with the second end of the first-stage, a second end opposite the first end of the second-stage, and a second inner channel for transmitting the pressure pulses to the surgical cutter. The second inner channel has a second cross-sectional area that is different than the first cross-sectional area.

Another embodiment of the invention provides an ophthalmic surgical cutting apparatus that includes a surgical cutter, a first tubing, and a second tubing. The first tubing is configured to transmit a first plurality of pressure pulses to the surgical cutter. The second tubing is configured to transmit a second plurality of pressure pulses to the surgical cutter. The first tubing includes multiple stages and has a length of about two feet or more. The multiple stages include a first-stage and a second stage. The first-stage has a first end configured to be connected to an output port of a pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the first plurality of pressure pulses to the surgical cutter. The first inner channel has a first cross-sectional area. The second-stage has a first end configured to be in pneumatic communication with the second end of the first-stage, a second end opposite the first end of the second-stage, and a second inner channel for transmitting the first plurality of pressure pulses to the surgical cutter. The second inner channel has a second cross-sectional area that is different than the first cross-sectional area.

Further embodiments of the invention provide a tubing assembly including multistage tubing. The multi-stage tubing is configured to be connected to a pneumatic pulse generator and to a surgical cutter and transmits pressure pulses to the surgical cutter. The multistage tubing includes a first-stage and a second-stage. The first-stage has a first end configured to be connected to an output port of the pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the pressure pulses to the surgical cutter. The first inner channel has a first cross-sectional area. The second-stage has a first end configured to be in pneumatic communication with the second end of the first-stage, a second end opposite the first end of the second-stage, and a second inner channel for transmitting the pressure pulses to the surgical cutter. The second inner channel has a second cross-sectional area that is different than the first cross-sectional area.

Yet further embodiments of the invention provide an ophthalmic surgical cutting apparatus having a surgical cutter and a tubing assembly. The surgical cutter is configured to be driven by a pneumatic pulse generator having an output port providing pressure pulses at a frequency of about 40 Hz or more. The tubing assembly includes multi-stage tubing connecting the pneumatic pulse generator to the surgical cutter and transmitting the pressure pulses from the pneumatic pulse generator to the surgical cutter. The multi-stage tubing has a length of about two feet or more and includes a first-stage tube and a second-stage tube. The first-stage tube has a first end configured to be connected to the output port of the pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the pressure pulses to the surgical cutter. The first inner channel has a first diameter. The second-stage tube has a first end configured to be in pneumatic communication with the second end of the first-stage tube, a second end opposite the first end of the second-stage tube, and a second inner channel for transmitting the pressure pulses to the surgical cutter. The second inner channel has a second diameter that is different than the first diameter.

These and other aspects of the invention, together with the organization and operation thereof, will become apparent from the following detailed description when taken in conjunction with the accompanying drawings.

DRAWINGS

FIGS. 1a and 1b schematically illustrate prior art ophthalmic surgical cutting apparatuses in an exploded view.

FIG. 2 is a graph of a desired waveform for pressure pulses used to operate the cutting apparatuses of FIGS. 1a and 1 b.

FIGS. 3a-3e schematically illustrate ophthalmic surgical cutting apparatuses according to embodiments of the present invention.

FIGS. 4 and 5 are perspective views of the multi-stage tubing included in the cutting apparatuses of FIG. 3a -3 d.

FIGS. 6 and 7 are cross-sectional views of the multi-stage tubing included in the cutting apparatuses of FIGS. 3a -3 d.

FIG. 8 is a graph illustrating pressure pulse amplitudes for various multi-stage tubing configurations.

DETAILED DESCRIPTION

Before any embodiments of the invention are explained in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of components set forth in the following description or illustrated in the following drawings. The invention is capable of other embodiments and of being practiced or of being carried out in various ways.

FIG. 1a schematically illustrates a prior art ophthalmic surgical cutting apparatus 10. The apparatus 10 includes a surgical cutter 12, a pneumatic pulse generator or driver 14, and a tubing assembly 16. The surgical cutter 12 is used to perform eye surgeries and includes a hollow needle 20 and a cutter positioned inside the needle 20 (not shown). The cutter is slidable (e.g., reciprocating, vibrating, or a combination thereof) and has a stroke of about one millimeter. In use, surgical cutter 12 is inserted into an incision in the eye. As vitreous tissue enters a port 24 of the needle 20, the cutter moves past the port 24 to cut the tissue. In some embodiments, a vacuum is applied to an aspiration line 25 of the surgical cutter 12 to remove the cut tissue from the surgical cutter 12.

The driver 14 includes an output port 26. The driver 14 is configured to generate pressure pulses (e.g., of air or nitrogen) at a fixed or variable frequency. In some embodiments, a surgeon or other individual operating the driver 14 can select a desired frequency. For example, a surgeon can control the driver 14 to generate pressure pulses at a frequency from about 4 Hz to about 20 Hz to perform fast tissue removal or to generate a single pressure pulse for performing a single cut. A surgeon can also control the driver 14 to generate pressure pulses at a frequency from about 20 Hz to about 83 Hz to perform very small smooth cuts (e.g., near the retina). Therefore, the driver 14 can provide pressure pulses at a frequency from about 2 Hz to about 83 Hz. In some arrangements the driver 14 is part of a console, such as AVE (“Adjustable Vit Enhancer”) console available from Medical Instrument Development Laboratories, Inc., which provides pressure pulses (i.e., pulse trains) at a frequency from about 10 Hz to about 42 Hz.

The driver 14 provides the generated pressure pulses to the output port 26. To generate the pressure pulses, the driver 14 includes a compressed gas or fluid source, such as air or nitrogen, and one or more solenoid valves, one or more motor-driven valves, a piston-type pressure pulse generator, or a combination thereof. In some embodiments, the driver 14 also includes one or more pressure regulators, one or more accumulators (e.g., capacitors), or a combination thereof to generate the pressure pulses in a predetermined waveform.

The tubing assembly 16 connects the surgical cutter 12 to the driver 14. The tubing assembly 16 includes a single piece of continuous tubing 30 having a length of about 80 inches (e.g., 78.7 inches). The tubing 30 includes a single channel having a constant inner diameter. The inner diameter of the tubing 30 is about 1/16 of an inch. The tubing assembly 16 also includes a fitting 32 that allows the tubing 30 to be quickly connected to the output port 26 of the driver. In some arrangements, the fitting 32 is an oversized tube barb that holds the tubing 30 securing to the output port 26. At the other end of the tubing 16, the tubing fits over a connector 34 coupled to the surgical cutter 12.

The pressure pulses generated by the driver 14 travel the length of the tubing assembly 16 and force the cutter (e.g., through a flexible diaphragm) against a bias of the cutter (e.g., generated by a static biasing force, such as a preloaded spring) and into a cutting position where the cutter slides past the cutting port 24 of the needle 20 and cuts the tissue. Between peaks of the pressure pulses, the pressure in the tubing assembly 16 is vented to atmosphere. Therefore, the pressure pulses return through the tubing assembly 16 to the driver 14, which allows the biasing force to return the cutter to the non-cutting position. Accordingly, each pressure pulse results in a single cutting motion of the cutter.

As noted above, in some embodiments, the cutter in the surgical cutter 12 may have little or no biasing force holding the cutter in the non-cutting position. In this embodiment, two pneumatic pulse generators or drivers and two tubing assemblies are used as illustrated in FIG. 1b . A first driver 14 a transmits pressure pulses to the cutter via a first tubing assembly 16 a to force the cutter into the cutting position. A second driver 14 b transmits pressure pulses to the cutter via a second tubing assembly to restore the cutter to the non-cutting position. In some embodiments, the two drivers 14 a and 14 b are embodied as a single device. The single device can include two pulse generators, each with a separate output. In other embodiments, the single device can include a single pulse generator that supplies pressure pulses over two different outputs at different amplitudes, frequencies, and/or phases.

As illustrated in FIG. 1b , the tubing assemblies 16 a and 16 b have similar properties as the tubing assembly 16 described above with respect to FIG. 1a . In particular, each tubing assembly 16 a and 16 b includes the tubing 30 that includes a single channel having a constant inner diameter of about 1/16 of an inch. The first tubing assembly 16 a also includes a fitting 32 a that allows the tubing 30 to be quickly connected to a first output port 26 a of the first driver 14 a. Similarly, the second tubing assembly 16 b includes a fitting 32 b that allows the tubing 30 to be quickly connected to a second output port 26 b of the second driver 14 b. In some arrangements, the fittings 32 a and 32 b are oversized tube barbs that provide high flow while holding the tubing 30 securely to the output ports 26 a and 26 b. At the other end of the tubing assemblies 16 a and 16 b, the tubing 30 fits over a first connector 34 a and a second connector 34 b coupled to the surgical cutter 12.

The driver 14 (including the drivers 14 a and 14 b) generates pressure pulses in a predetermined waveform. For example, FIG. 2 illustrates an example waveform 40 of pressure pulses generated by the driver 14. The period (p) and amplitude (a) of the pressure pulses define the force and timing of the pressure pulses impacting the surgical cutter 12, which is translated into cutting actions by the surgical cutter 12. Ideally, the amplitude of each pressure pulse should have a high differential between its peak amplitude 42 (e.g., measured in pounds per square inch (“PSI”) and its minimum amplitude 44 (e.g., also measured in PSI). This high differential creates a strong pressure pulse that provides sufficient and controlled force to the surgical cutter 12, which results in a precise cutting motion of the cutter. Precise cutting motion is particularly important when performing surgery within the small and delicate areas of an eye.

The waveform observed at the end of the tubing 30 coupled to the surgical cutter 12, however, normally contains many “defects” that make the waveform different than the relatively clean rectangular waveform generated by the driver 14. The defects may be partially caused by turbulence and high velocity of air flow at certain points or times in the tubing 30 or inside the driver 14. These defects impact the precision of the cutting performed by the surgical cutter 12. These defects become generally more extreme at higher cutting rates (e.g., when more than one pressure pulse is in the tubing 30 and traveling in different directions). This often occurs when pressure pulses having a frequency of about 45 Hz or more are transmitted in tubing having a length of approximately 80 inches (e.g., 78.7 inches).

To prevent or limit these waveform defects, the length of the tubing can be shortened. However, a longer length of tubing may be necessary based on the position of the driver 14 and the patient. For example, if tubing with a length substantially less than 80 inches is used to transmit pulse trains to the cutter 12, the driver 14 may be required to be located in close proximity to the patient or even on the patient, which may not be practical or desired. Alternatively, a vacuum can be applied to the inner channel of the tubing between pressure pulses. The vacuum creates a higher differential between a peak amplitude and minimum amplitude than when the tubing is vented to atmosphere. However, the use of the vacuum does not prevent any defects of the pressure pulses caused by turbulence or other high air velocity. In addition, the use of a vacuum increases the complexity and cost of the surgical equipment. Accordingly, these solutions have not adequately addressed the undesirable impact of these waveform defects on the performance of the cutter.

FIG. 3a schematically illustrates an ophthalmic surgical cutting apparatus 50 according to embodiments of the present invention. The apparatus 50 includes a surgical cutter 52, a pneumatic pulse generator or driver 54, and a tubing assembly 56. The surgical cutter 52 is similar to the surgical cutter 12 described above with respect to FIG. 1 a. In particular, the surgical cutter 52 includes a hollow needle 58 and a cutter (not shown) contained inside the needle 58. In some arrangements, the surgical cutter 52 also includes an aspiration line 59 for connecting a vacuum to the cutter 52 to remove cut tissue.

The driver 54 is also similar to the driver 14 described above with respect to FIG. 1a . In particular, the driver 54 includes an output port 57 for transmitting pressure pulse trains to the surgical cutter 52. As described above for the driver 14, the driver 54 can generate pressure pulse trains at a fixed or a variable frequency, and, in some embodiments, a surgeon or other individual can control the driver 54 to generate pressure pulses at a desired frequency. The driver 54 can provide a similar range of frequencies as the driver 14 (e.g., about 2 Hz to about 83 Hz). In addition, in some embodiments, the driver 54 provides pressure pulses at higher frequencies. For example, the frequency could be about 133 Hz, about 167 Hz, or about 200 Hz.

The tubing assembly 56 connects the surgical cutter 52 to the driver 54. The tubing assembly 56 includes multi-stage tubing 60 that includes an inner channel that transmits the pressure pulses from the driver 54 to the cutter 52. The multi-stage tubing 60 has a total length of about two feet or more and, in some embodiments, has a length of about 80 inches (e.g., 78.7 inches).

Unlike the tubing 30 described above with respect to FIGS. 1a and 1b , the inner channel of the multi-stage tubing 60 has a non-constant cross-sectional area. In particular, as illustrated in FIG. 3, the multi-stage tubing 60 includes a first-stage tube 62 and a second-stage tube 64. The first-stage tube 62 has a first end 62 a and a second end 62 b opposite the first end 62 a. The first end 62 a is configured to be connected to the output port 57 of the driver 54 (e.g., through a fitting 63). The first-stage tube 62 has a first length 62 c (see FIG. 4, not to scale) and a first inner channel 62 d having a first cross-sectional area 62 e (see FIG. 6, not to scale).

The second-stage tube 64 has a first end 64 a and a second end 64 b opposite the first end 64 a. The first end 64 a is configured to be connected to the second end 62 b of the first-stage tube 62. In some embodiments, the second end 64 b is configured to fit over a connector 65 coupled to the surgical cutter 12. The second-stage tube 64 has a second length 64 c (see FIG. 5, not to scale) and a second inner channel 64 d having a second cross-sectional area 64 e (see FIG. 7, not to scale).

As illustrated in FIG. 3a , the first-stage tube 62 and the second-stage tube 64 are connected by one or more adapters 70, such as a double-barb fitting that fits within the inner channel of each tube 62 and 64. It should be understood that in other embodiments, the first-stage tube 62 and the second-stage tube 64 are formed as a single continuous piece of tubing. In these embodiments, the adapter 70 is not used. Nonetheless, distinct stages exist.

The second cross-sectional area 64 e along a substantial portion of the second length 64 c of the second-stage tube 64 is different than the first cross-sectional area 62 e along a substantial portion of the length 64 c of the first-stage tube 64 and, in some embodiments, is smaller than the first cross-sectional area 62 e. For example, in some embodiments, the second inner channel 64 d is cylinder-shaped and has a diameter of about 1/16 of an inch, and the first inner channel 62 d is cylinder-shaped and has a diameter of about 3/32 of an inch. In some embodiments, the first cross-sectional area 62 e and the second cross-sectional area 64 e are each constant along the entire lengths 62 d and 64 d, respectively. However, in other embodiments, the cross-sectional area of one or both of the inner channels of the tubes 62 and 64 varies along the length of the tube. For example, the cross-sectional area of an inner channel may be varied to create a cone-shaped or wave-shaped channel for transmitting the pressure pulses. In these embodiments, the average cross-sectional area of the first inner channel 62 d of the first-stage tube 62 is different than (e.g., larger than) the average cross-sectional area of the second inner channel 64 d of the second-stage tube 64.

It should also be understood that although the cross-sectional areas of the first inner channel 62 d and the second inner channel 64 d are different, the first-stage tube 62 and the second-stage tube 62 may have different or the same overall (i.e., measured from their external surfaces) cross-sectional areas depending on the thickness of the walls of each tube defining the inner channel. Furthermore, although the first and second inner channels 62 d and 64 d are illustrated as having a cylinder-shape with a circular cross-sectional area, in some embodiments, at one or more points along the multi-stage tubing 60, the inner channel has a non-circular cross-sectional area. For example, the inner channel contained in the first-stage tube 62 and/or the second-stage tube 64 can have a polygonal-shaped (e.g., rectangular, hexagon, octagon, etc.) or a curved-shaped (e.g., oval) cross-sectional area. Also, in some embodiments, the tubes 62 and 64 each include one or more additional channels (e.g., a second pressure pulse channel may be used to return a cutter to a non-cutting position, instead of biasing the cutter as described above), and each additional channel may have the same or a different cross-sectional area than the areas 62 e and 64 e.

In some embodiments, the second length 64 c of the second-stage tube 64 is also different than the first length 62 c of the first-stage tube 62. For example, in one configuration the second length 64 c is less than the first length 62 c of the first-stage tube 62 (see FIG. 3e ). In some embodiments, the ratio of the first length 62 c to the second length 64 c is about 6 to 1.

FIG. 8 is a graph 100 illustrating the peak and minimum amplitude of pressure pulses transmitted along various configurations of the multi-stage tubing 60 having an overall fixed length of about 80 inches (e.g., 78.7 inches) and having various second lengths 64 c of the second-stage tube 64 (e.g., using a 133 Hz drive frequency). The measured amplitudes are the amplitudes measured at the end of the tubing assembly normally coupled to the surgical cutter. Therefore, the measured amplitudes represent the peak and minimum of the pulses received at the surgical cutter. As described above, to provide proper cutting motion, the differential between the peak and minimum amplitude of the pressure pulse should be as large as possible.

As illustrated in FIG. 8, when the prior art continuous tubing 30 (having an inner cylinder-shaped channel with a constant diameter) is used to transmit pressure pulses, the peak amplitude of the pulses is about 24.5 PSI and the minimum amplitude of the pulses is about 11.9 PSI. However, as shown in FIG. 8, when the multi-stage tubing 60 is used to transmit pressure pulses (with stages having inner channels with different cross-sectional areas), the peak and minimum of the pressure pulses are at least the same as those for the continuous tubing 30 and, in many configurations, are better. In particular, the pressure pulse reaches a peak amplitude of about 26.2 PSI and a minimum amplitude of 10.3 PSI when the multi-stage tubing 60 is used with a second-stage tube 64 that has a second length 64 c of about 11 inches (and, consequently, a first-stage tube 62 having a first length 62 c of about 68 inches when the multi-stage tubing 60 has a total or combined length of about 80 inches). Other lengths of the first-stage tube 62 and the second-stage tube 64 can also be used that result in better peak and minimum amplitudes than when the continuous tubing 30 is used. For example, TABLE 1 below provides the peak and minimum (or “residual”) amplitudes of the pressure pulses using various lengths of the second-stage tube 64 (and, subsequently, various lengths of the first-stage tube 62 assuming the tubing 60 has a combined length of about 78.7 inches).

TABLE 1 Second-Stage Tube Length First (in inches) Peak PSI Residual PSI Average PSI Harmonic dBm 0.0 24.2 11.9 18.8 −14.74 9.8 26.2 10.2 18.9 −12.47 10.8 26.2 9.7 18.6 −12.12 12.5 26.2 10.3 18.8 −12.35 24 25.3 11.1 18.7 −13.59 36 24.1 11.2 18.7 −14.8 78.7 24.2 11.9 18.9 −15.31

Therefore, as shown in FIG. 8 and TABLE 1, using the multi-stage tubing 60 generally results in the surgical cutter receiving an improved pressure pulse as compared to when the continuous tubing 30 is used. In particular, the inventors believe that propagating the pressure pulse through a higher-volume but lower-loss tube, such as the first-stage tube, and then through a lower-volume but higher-loss tube, such as the second-stage tube, results in an improved pressure pulse received by the surgical cutter.

It should be understood that the multi-stage tubing 60 can include additional tubes. For example, in some embodiments, the multi-stage tubing 60 includes a third-stage tube. The third-stage tube has a first end, a second end opposite the first end, and an inner channel. The first end of the third-stage tube is in pneumatic communication with the second end 64 b of the second-stage tube 64 and the second end of the third-stage tube is in pneumatic communication with the surgical cutter 52. In some embodiments, the inner channel of the third-stage tube has the same cross-sectional area as the first-stage tube 62. In this configuration, the tubing assembly 56 provides three-stage tubing that includes a middle stage (i.e., the second-stage tube 64) that has a smaller diameter (or cross-sectional area) than the two end stages (i.e., the first-stage tube 62 and the third-stage tube). It should be understood, however, that the inner channel of the third-stage tube (and any other tubes included in the multi-stage tubing 60) can have a different cross-sectional area than the first-stage tube 62 and can have the same or a different cross-sectional area than the second-stage tube. For example, when the tubing assembly 56 provides three-stage tubing, the three-stage tubing can include an inner channel that has a middle stage (i.e., the second-stage tube 64) that has a larger cross-sectional area than the two end stages (i.e., the first-stage tube 62 and the third-stage tube). Also, in some embodiments, each inner channel of the three tubes may have a different cross-sectional area and may create a channel that decreases in cross-sectional area as it reaches the surgical cutter. For example, in some arrangements, the first-stage tube 62 has an inner channel 62 d that has a first diameter (e.g., about 4/32 of an inch), the second-stage tube 64 has an inner channel 64 d that has a second diameter smaller than the first diameter (e.g., about 3/32 of an inch), and the inner channel of the third-stage tube has a third diameter smaller than the second diameter (e.g., about 1/16 of an inch). If additional tubes are included in the multi-stage tubing 60, the tubes may form similar patterns as described above for the three-stage tubing.

It should be understood that the multi-stage tubing 60 can be used in embodiments where two pressure pulses or pulse trains are used to drive the cutter. For example, as illustrated in FIG. 3b , in one alternative, two tubing assemblies are used to convey pressure pulses to the surgical cutter 12 and one or both of the tubing assemblies can include the multi-stage tubing 60 as described above. In particular, as illustrated in FIG. 3b , a first driver 54 a transmits pressure pulses to the surgical cutter 52 via a first tubing assembly 56 a to force the cutter into the cutting position. A second driver 54 b transmits pressure pulses to the cutter via a second tubing assembly 56 b to restore the cutter to the non-cutting position. In some embodiments, the two drivers 54 a and 54 b are embodied as a single device. The single device can include two pulse generators, each with a separate output (see FIG. 3c ). In other embodiments, the single device can include a single pulse generator that supplies pressure pulses or pulse trains over two different outputs at different amplitudes, frequencies, and/or phases (see FIG. 3d ).

As illustrated in FIG. 3b , one or both of the first and second tubing assemblies 56 a and 56 b have similar properties as the tubing assembly 56 described above with respect to FIG. 3a . In particular, one or both of the tubing assemblies 56 a and 56 b includes the multi-stage tubing 60 described above with respect to FIG. 3a . Therefore, one or both of the tubing assemblies 56 a and 56 b includes the first-stage tube 62 and the second-stage tube 64 as described above with respect to FIG. 3 a.

In particular, in some embodiments, the first tubing assembly 56 a includes the first-stage tube 62 and the second-stage 64. The first-stage tube 62 has a first end 62 a and a second end 62 b opposite the first end 62 a. The first end 62 a is configured to be connected to a first output port 57 a of the first driver 54 a (e.g., through a fitting 63). The second-stage tube 64 has a first end 64 a and a second end 64 b opposite the first end 64 a. The first end 64 a is configured to be connected to the second end 62 b of the first-stage tube 62. In some embodiments, the second end 64 b is configured to fit over a connector 65 a coupled to the surgical cutter 12. The first-stage tube 62 and second-stage tube 64 can be connected by an adapter 70 or can be formed as a single continuous piece of tubing.

Similarly, in some embodiments, the second tubing assembly 56 b includes the first-stage tube 62 and the second-stage 64. The first-stage tube 62 has a first end 62 a and a second end 62 b opposite the first end 62 a. The first end 62 a is configured to be connected to a second output port 57 b of the second driver 54 b (e.g., through a fitting 63). The second-stage tube 64 has a first end 64 a and a second end 64 b opposite the first end 64 a. The first end 64 a is configured to be connected to the second end 62 b of the first-stage tube 62. In some embodiments, the second end 64 b is configured to fit over a connector 65 b coupled to the surgical cutter 12. The first-stage tube 62 and second-stage tube 64 can be connected by an adapter 70 or can be formed as a single continuous piece of tubing.

It should be understood that in the embodiments of FIGS. 3b -3 d, one or both of the tubing assemblies 56 a and 56 b can include the multi-stage tubing 60. For example, in some embodiments, only one of the first and second tubing assemblies 56 a and 56 b include the multistage tubing 60 and the other tubing assembly includes the prior art tubing 30 described above with respect to FIG. 1b . Furthermore, in some embodiments, more than two tubing assemblies 56 are connected to the surgical cutter 56 and, in these embodiments, at least one of the tubing assemblies includes the multi-stage tubing 60 as described above. In addition, it should be understood that the tubing assemblies 56 a and 56 b can include all of the various configurations of the multi-stage tubing 60 as described above with respect to FIG. 3 a.

It should be understood that (and as is indicated above) the term “multi-stage” as used in the present application is not limited to tubing including individual pieces of tubing each having an inner channel having a constant cross-sectional area along the entire length of the individual piece of tubing. In particular, the term “multi-stage” also encompasses a single, continuous piece of tubing that includes an inner channel that has at least two different cross-sectional areas at various points along the length of the tubing (i.e., at least two stages). In addition, when the multi-stage tubing includes individual pieces of tubing or a single, continuous piece of tubing, the tubing may an inner channel having two or more different cross-sectional areas that are constructed in a step-wise fashion (e.g., 1/16 of an inch stepped to 3/32 of an inch) or in a continuously-variable fashion (e.g., 1/16 of an inch continuously increased over a length of tubing to 3/32 of an inch). When different cross-sectional areas or inner diameters are constructed in a continuously-variable fashion, the multi-stage tubing may include an infinite number of “stages,” wherein at least two of the “stages” have an inner channel with different cross-sectional areas. Various combinations of these multi-stage tubing configurations are also possible. For example, the multi-stage tubing can include a continuous piece of tubing that includes an inner channel with two or more different cross-sectional areas constructed in a stepwise fashion and two or more different cross-sectional areas constructed in a continuously variable fashion. The multi-stage tubing can also include a continuous piece of tubing with an inner channel including at least two different cross-sectional areas (e.g., representing a first and second “stage” of tubing) and an individual piece of tubing coupled (e.g., through use of an adaptor) to the continuous piece of tubing (e.g., representing a third “stage” of tubing) or vice versa.

Various features of the invention are set forth in the following claims. 

What is claimed is:
 1. An ophthalmic surgical cutting apparatus, the apparatus comprising: a pneumatically-powered surgical cutter; a first tubing assembly transmitting a first plurality of pressure pulses from a pneumatic pulse generator to the pneumatically-powered surgical cutter; and a second tubing assembly transmitting a second plurality of pressure pulses from the pneumatic pulse generator to the pneumatically-powered surgical cutter; the first tubing assembly comprising multi-stage tubing having a length of about two feet or more and including a first-stage, the first-stage having a first end coupled to an output port of the pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the first plurality of pressure pulses to the surgical cutter, the first inner channel having a first cross-sectional area, and a second-stage, the second-stage having a first end in pneumatic communication with the second end of the first-stage, a second end opposite the first end of the second-stage coupled to the pneumatically-powered surgical cutter, and a second inner channel for transmitting the first plurality of pressure pulses to the surgical cutter, the second inner channel having a second cross-sectional area different than the first cross-sectional area.
 2. The cutting apparatus of claim 1, wherein the second tubing assembly comprises multi-stage tubing having a length of about two feet or more and including a first-stage, the first-stage having a first end coupled to an output port of a pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the second plurality of pressure pulses to the surgical cutter, the first inner channel having a first cross-sectional area, and a second-stage, the second-stage having a first end in pneumatic communication with the second end of the first-stage, a second end opposite the first end of the second-stage coupled to the pneumatically-powered surgical cutter, and a second inner channel for transmitting the second plurality of pressure pulses to the surgical cutter, the second inner channel having a second cross-sectional area different than the first cross-sectional area.
 3. The cutting apparatus of claim 2, wherein the first end of the first-stage of the first tubing assembly is configured to be connected to a first output port of a pneumatic pulse generator and wherein the first end of the first-stage of the second tubing assembly is configured to be connected to a second output port of the pneumatic pulse generator.
 4. The cutting apparatus of claim 2, wherein the first end of the first-stage of the first tubing assembly is configured to be connected to a first output port of a first pneumatic pulse generator and wherein the first end of the first-stage of the second tubing assembly is configured to be connected to a second output port of a second pneumatic pulse generator.
 5. The cutting apparatus of claim 1, wherein the second cross-sectional area is smaller than the first cross-sectional area.
 6. The cutting apparatus of claim 1, wherein the first-stage has a first length and the second-stage has a second length.
 7. The cutting apparatus of claim 6, wherein the second length is shorter than the first length.
 8. The cutting apparatus of claim 6, wherein the second length is about 11 inches.
 9. The cutting apparatus of claim 6, wherein the first cross-sectional area is substantially constant along the entire first length.
 10. The cutting apparatus of claim 6, wherein the second cross-sectional area is substantially constant along the entire second length.
 11. The cutting apparatus of claim 6, wherein the ratio of the first length to the second length is about 6 to
 1. 12. The cutting apparatus of claim 1, wherein the first tubing assembly includes an adapter coupling the first-stage to the second stage.
 13. The cutting apparatus of claim 1, wherein the multi-stage tubing comprises a continuous single piece of tubing including the first-stage and the second-stage.
 14. The cutting apparatus of claim 13, wherein the continuous single piece of tubing includes the first-stage and the second-stage constructed in a step-wise fashion.
 15. The cutting apparatus of claim 13, wherein the continuous single piece of tubing includes the first-stage and the second-stage constructed in a continuously-variable fashion.
 16. The cutting apparatus of claim 13, wherein the continuous single piece of tubing includes an inner channel having a continuously-variable cross-sectional area over substantially an entire length of the continuous single piece of tubing.
 17. The cutting apparatus of claim 1, wherein the first cross-sectional area is a circular cross-sectional area with a diameter of about 3/32 of an inch and the second cross-sectional area is a circular cross-sectional area with a diameter of about 1/16 of an inch.
 18. The cutting apparatus of claim 1, wherein the tubing assembly transmits the first plurality of pressure pulses to the surgical cutter at a rate of approximately 40 Hz or more.
 19. The cutting apparatus of claim 1, wherein the tubing assembly transmits the first plurality of pressure pulses to the surgical cutter at a rate of approximately 80 Hz or more.
 20. The cutting apparatus of claim 1, wherein at least one of the first cross-sectional area and the second cross-section area is a non-circular cross-sectional area.
 21. An ophthalmic surgical cutting apparatus, the apparatus comprising: a pneumatically-powered surgical cutter driven by a pneumatic pulse generator having an output port providing pressure pulses at a variable frequency; and a tubing assembly comprising multi-stage tubing connecting the pneumatic pulse generator to the surgical cutter and for transmitting the pressure pulses from the pneumatic pulse generator to the surgical cutter, the multi-stage tubing having a length of about two feet or more and including a first-stage tube, the first-stage tube having a first end coupled to the output port of the pneumatic pulse generator, a second end opposite the first end, and a first inner channel for transmitting the pressure pulses to the surgical cutter, the first inner channel having a first diameter, and a second-stage tube, the second-stage tube having a first end in pneumatic communication with the second end of the first-stage tube, a second end opposite the first end of the second-stage tube coupled to the pneumatically-powered surgical cutter, and a second inner channel for transmitting the pressure pulses to the surgical cutter, the second inner channel having a second diameter different than the first diameter. 